A multinational study to measure the value that patients with cancer place on improved emesis control following cisplatin chemotherapy.

BACKGROUND: The neurokinin-1 (NK1) receptor antagonists are a new class of agents designed to reduce the risk of emesis following chemotherapy, particularly with cisplatin. Early data from double-blind randomised trials suggest that an orally administered NK1 antagonist can reduce the absolute risk of acute and delayed emesis following cisplatin by 20 and 30%, respectively. OBJECTIVE: To measure the value that patients with cancer place on improved emesis control and quality of life. DESIGN: Willingness-to-pay analysis. SETTING: Five study sites in Canada, Italy, Spain and Greece. PATIENTS AND PARTICIPANTS: 245 patients with cancer either receiving chemotherapy with cisplatin or who had received cisplatin-based chemotherapy within the previous 6 months. METHODS: After background information had been presented, patients were asked to define the maximum that they would pay per day for a drug that reduced their risk of acute and delayed (days 2 to 5) emesis by 20 and 30%, respectively. Costs were converted to US dollars ($US) using year 2000 exchange rates. RESULTS: For a 20% improvement in acute emesis, Canadian, Italian and Spanish patients with cancer were willing to pay $US46, $US34 and $US63 per day, respectively, compared with $US8 for patients from Greece (p < 0.001). For a 30% improvement in delayed emesis, Canadian, Italian and Spanish patients with cancer were also willing to pay more than their Greek counterparts (SUS41, $US31, $US50 and $US9 daily for 4 days, respectively; p < 0.001). These significant differences in patient value between countries remained, even after adjusting for socioeconomic variables and previous history of emesis. CONCLUSIONS: There are substantial cultural differences in how patients with cancer value benefit and improved quality of life. Since the majority of the world's population resides outside North America and Western Europe, there may be a need to re-evaluate perceived levels of patient benefit and measures of quality of life.

Economic evaluation of nimesulide versus diclofenac in the treatment of osteoarthritis in Greece.

OBJECTIVE: To evaluate, from a social security system perspective, the economic consequences of treating rheumatic diseases with nimesulide or diclofenac. DESIGN: Cost-minimisation analysis was used to estimate the incremental direct medical cost and the cost of gastrointestinal adverse events for 15 days' treatment with nimesulide compared with diclofenac. Cumulative incidence of adverse events was calculated through meta-analysis of the results of double-blind randomised clinical trials. The therapeutic pathway for ambulatory care resource use was determined by a panel of experts, and direct hospital costs were estimated from a sample of 43 patients. MAIN OUTCOME MEASURES AND RESULTS: The 15-day treatment cost with nimesulide was 35.9% lower compared with diclofenac due to the lower incidence of adverse events. Our analysis showed that nimesulide generated a cost saving of $US20.98 per patient depending on the dosage of diclofenac used.